Lets Talk: Epinephrine

Greetings!

For this weeks topic I was going to talk about Epinephrine and how it is used in Anaphylaxis and CPR. However as I was reading through my sources, it touched on how Epi is used to manage hypotension in septic patients. It made me remember a class I was taught on how to set up a dirty Epi drip. A dirty Epi drip is a quick concoction that a paramedic can set up when caring for a patient who's hypotension is a result of sepsis. Thus Let's quickly introduce Epi and its common uses and then get into how to set up a dirty Epi. 

Epinephrine also commonly known as adrenaline is a hormone produced by the adrenal medulla (a gland located on top of kidneys) It stimulates the sympathetic nervous system which is responsible for fight or flight. In Medicine, injecting Epinephrine (EPI) has long been used to treat Anaphylaxis (severe allergic reaction on a systemic level) and a part of the advanced Cardiovascular life support (ACLS) algorithm. 

Anaphylaxis

In cases of systemic response to an allergen, the body can display edema all over including the lungs, which makes the primary concern, loss of airway, there are other symptoms but the airway is the main concern. Epinephrine acts as a bronchodilator, meaning it opens up the bronchi allowing air to flow in

Adult dosage:

0.3-0.5 mg/ml of 1:1000 Epi (meaning there is 1g of Epi per 1liter of normal saline solution)

Pediatric dosage:

usually half, 0.15-0.3 mg/ml. A better way to do it would be per weight. 0.01mg/kg of body weight and no more than 0.3mg in total. 

Cardiac Epi 

The only difference in dosage is the concentration, cardiac Epi is 1:10,000 meaning 1g of Epi per 10 liters of normal saline solution). Epi is used in the ACLS algorithm typically during asystole, ventricular fibrillation, pulseless electrical activity, or pulseless ventricular tachycardia in hopes to gain return of spontaneous circulation (ROSC) 

adult dosage:

1mg every 3-5 min 

pediatric dosage:

0.01mg/kg every 3-5 min (max 1mg)

NOW lets talk about a Diry Epi 

Imagine you have a patient and they have sepsis, their blood pressure is tanking, you need to get them to a higher level of care or this person will not make it. So how can you stabilize their now blood pressure while getting them to the hospital? A dirty Epi drip! Emergency medical response associate program recommends 1ug/ml. That looks like a very small dose, you can actually make that by mixing 0.1ml of cardiac Epi into 1 liter bag of normal saline. Then using an 18G (size of catheter in the arm) needle catheter and a 20 gtts macro drip set (size of tubing) you can expect to deliver about 20-30ug/min and of course titrate appropriately. This will hopefully keep the blood pressure stable until you can deliver your patient to a doctor that can care for the root of the problem. 

Lil' chicken sibling things

Source: 

Dalal, R. (2024, November 23). Epinephrine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482160/

Ernst , R., Guest, B., & Herbert, M. (2021, February 2). Bedside Epinephrine Drip (“Dirty Epi Drip”) Ryan Ernst, MD. emrap. https://www.emrap.org/corependium/chapter/recJCKsNuvUC7XNDn/Bedside-Epinephrine-Drip-Dirty-Epi-Drip